With the prospect of tens of thousands of HIV positive people in its district needing medical help in the next few years, the tiny, 300-bed Hlabisa Hospital has turned its attention to encouraging people to care for terminally ill relatives at home.

Once patients are in the terminal stages of AIDS, the hospital will be forced through lack of resources to send them home to die. But home-based care won’€™t be easy. The area is poverty-stricken and most homes lack running water.

“Nobody seems to be taking note of the fact that there will be a huge demand for health services in the next few years,” says Hospital superintendent Dr Sean Drysdale. “There is no budget or plans to expand the hospital.”

In addition,government continues to freeze healthworkers’€™ posts at hospitals and clinics throughout the province.

The hospital serves about 220 000 people from four tribal authorities, about half the population of the Durban metro. Already, is 130% full. Yet at least one in three people in the district are estimated by the health department to be HIV positive. Once the epidemic moves from HIV to AIDS, demands on the hospital and its staff will be overwhelming.

“In the past seven years, our TB patients have increased by 360%, largely because of the impact of HIV,” says Drysdale. “About 65% of all our TB patients are HIV-positive. In the normal medical wards, 60% of women patients and 54,3% of men are HIV positive.”

At Hlabisa, young, skeletal women shuffle listlessly around the TB ward. Others are too sick to move, their wasted, zig-zag bodies barely raising a lump in their hospital beds.

Charles Hlatswayo, AIDS counsellor at Mosvold Hospital in the Ingwavuma district to the north of Hlabisa, estimates that six or seven out of every 10 patients in his hospital are HIV-positive. Mosvold superintendent Dr Andrew Ross says that he expects 150 of his staff to die of AIDS in the next five years.

“We have been discussing with the community health workers what is the best way forward,” says Sister Ellen Dube, one of only two hospital AIDS counsellors. “We all agree that we must focus on getting people to accept HIV/AIDS and home-based care.”

Dube says there is still mass denial of the disease because people associate it with immoral behaviour. “More and more people are dying of AIDS now, especially the youth. But people prefer to visit the traditional healers and say they are bewitched, rather than accept their HIV status.”

As part of its campaign to establish an environment that accepts and supports HIV positive people, the hospital is trying to encourage people to take HIV tests. Drysdale says it is important for people to know their HIV status as this will enable them to take charge of their lives.

“There is life after HIV,” says Drysdale. “If you are HIV positive, you can lead a more healthy lifestyle, and you can start to plan for your dependents. If you are negative, don’€™t you want to know so that you make sure that you stay that way?”

Healthworkers will target pregnant women first in its voluntary testing campaign. “The carrot that we hope to offer them is anti-retroviral drugs for those who test HIV positive, to stop the transmission of the disease to their babies,” says Drysdale.

Although central government has ruled out supplying free anti-retroviral drugs for pregnant mothers, the drugs will be made available in Hlabisa as part of a collaborative research project between the health service and researchers at the nearby Africa Centre.

Despite the crisis, systematic, co-ordinated plans to halt the epidemic are thin on the ground. A range of organisations run parallel programmes, while young community AIDS educators go around day by day, randomly handing out condoms.

Hlabisa staff developed its holistic plan (see box) little over a month ago after waiting in vain for direction from provincial government.

Provincial health department spokesperson David McGlew says both provincial and national government acknowledge the lack of a comprehensive HIV/AIDS plan, but that AIDS was “something that humanity has never had to deal with before.. it’€™s almost like viral terrorism”.

“We are working on this, and there will be a major announcement in Durban on 29 October that will go a long way to addressing the very real concerns raised by Hlabisa about the lack of direction.”

McGlew added that KwaZulu-Natal was “horribly under-resourced”, and that the rationalisation of staff took time as it involved negotiations with unions about the transfer of staff. “Hlabisa is not an exception. I can take you to any corner of the province and show you how hospitals and clinics are battling to cope.”

He said all hospitals would be forced to send terminally ill AIDS patients home, but that carers would not be abandoned.

“The department plans to send out 300 to 400 people in the next six months to help with the training and support of those involved in home-based care,” he said, adding that carers would be given medicine and materials, and medical waste would be collected. ‘€“ health-e news service.